Physical Therapy is one of the fastest growing healthcare industries in the country, with new private practices opening daily. This is great for patients, because the number of clinics they have to choose from is getting larger, but it is not great for owners, because many insurance panels are being closed.

What is a closed panel?

To see a patient with a particular insurance and to receive payment for services provided, you will need to be an “in-network provider”. This means that you have been credentialed with the insurance company, they have verified your information and issued you a contract. When an insurance company feels that they have reached the adequate number of providers for a specialty, they will close that panel and no longer issue contracts for new providers. This can be extremely frustrating for a new business owner. For example, if you’re patient demographics are 80% Blue Cross Blue Shield and they tell you the panel is closed, how are you supposed to succeed?

How to beat the closed panel?

Many insurances will just tell you to call back in 6-12 months to see if the panel has re-opened.  But what they don't tell you is many insurance companies will accept some sort of appeal letter, allowing the practitioner to state their case for why an exception should be made. These appeal letters are not guaranteed to be accepted but we have discovered a few key factors that could increase your chances.

  1. Hours of operation- Go on Google and check out the hours of operation for clinics in your area who have the same specialty as your practice. Maybe you will see that there are no clinics open later than 6:00 PM, this is where you could prove your worth to the insurance companies. By adjusting your hours to meet the needs of your service location, insurance companies may make an exception because it benefits their members.
  2. Keep a list- If you have patients coming in to your clinic because they heard great about you or have been referred, but you cannot accept their insurance because of a closed panel, document it! Write down the patient’s name and member ID, then once you have a list of 50-100 patients, submit your appeal letter along with your list.  Showing the insurance company that their members are seeking you out can be a persuasive tool in getting into closed panel.
  3. Specialty- The amazing thing about Physical Therapy is that there are a lot of different specialties that can be included in a practice. Whether its orthopedics, sports medicine, or pediatrics, these specialties could be your golden ticket into a closed panel. Again, go onto Google, are there any clinics in your area that offer orthopedic therapy? If not, include that information in your appeal letter and the insurance company will take it into consideration when they have their monthly meetings.

As stated previously, none of these are guaranteed to sway the insurance into making an exception for your business but including the factors that set your business apart is certainly doesn’t hurt. If you have any credentialing questions, please feel free to reach out to the experts at Account Matters at 508-422-0231. 

3 Tips for Getting into Closed Panels

Article by Daniel Ramsey